新冠病毒感染 1 年后的神经系统结局：一项前瞻性纵向队列研究。
Neurological outcomes 1 year after COVID-19 diagnosis: A prospective longitudinal cohort study.
机构信息
Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria.
Department of Internal Medicine II, Medical University of Innsbruck, Innsbruck, Austria.
出版信息
Eur J Neurol. 2022 Jun;29(6):1685-1696. doi: 10.1111/ene.15307. Epub 2022 Mar 23.
BACKGROUND AND PURPOSE
Neurological sequelae from coronavirus disease 2019 (COVID-19) may persist after recovery from acute infection. Here, the aim was to describe the natural history of neurological manifestations over 1 year after COVID-19.
METHODS
A prospective, multicentre, longitudinal cohort study in COVID-19 survivors was performed. At a 3-month and 1-year follow-up, patients were assessed for neurological impairments by a neurological examination and a standardized test battery including the assessment of hyposmia (16-item Sniffin' Sticks test), cognitive deficits (Montreal Cognitive Assessment < 26) and mental health (Hospital Anxiety and Depression Scale and Post-traumatic Stress Disorder Checklist 5).
RESULTS
Eighty-one patients were evaluated 1 year after COVID-19, out of which 76 (94%) patients completed a 3-month and 1-year follow-up. Patients were 54 (47-64) years old and 59% were male. New and persistent neurological disorders were found in 15% (3 months) and 12% (10/81; 1 year). Symptoms at 1-year follow-up were reported by 48/81 (59%) patients, including fatigue (38%), concentration difficulties (25%), forgetfulness (25%), sleep disturbances (22%), myalgia (17%), limb weakness (17%), headache (16%), impaired sensation (16%) and hyposmia (15%). Neurological examination revealed findings in 52/81 (64%) patients without improvement over time (3 months, 61%, p = 0.230) including objective hyposmia (Sniffin' Sticks test <13; 51%). Cognitive deficits were apparent in 18%, whereas signs of depression, anxiety and post-traumatic stress disorders were found in 6%, 29% and 10% respectively 1 year after infection. These mental and cognitive disorders had not improved after the 3-month follow-up (all p > 0.05).
CONCLUSION
Our data indicate that a significant patient number still suffer from neurological sequelae including neuropsychiatric symptoms 1 year after COVID-19 calling for interdisciplinary management of these patients.
背景与目的
新冠病毒疾病 2019（COVID-19）后的神经系统后遗症可能在急性感染康复后仍持续存在。在这里，目的是描述 COVID-19 后 1 年以上神经系统表现的自然史。
方法
对 COVID-19 幸存者进行了一项前瞻性、多中心、纵向队列研究。在 3 个月和 1 年的随访中，通过神经系统检查和包括嗅觉减退（16 项 Sniffin' Sticks 测试）、认知缺陷（蒙特利尔认知评估<26）和心理健康（医院焦虑和抑郁量表和创伤后应激障碍清单 5）评估的标准化测试组合，对患者进行神经损伤评估。
结果
81 例患者在 COVID-19 后 1 年进行了评估，其中 76 例（94%）患者完成了 3 个月和 1 年的随访。患者年龄为 54 岁（47-64 岁），59%为男性。在 3 个月和 1 年时，分别发现 15%（3 个月）和 12%（10/81；1 年）的新发和持续神经系统疾病。81 例患者中有 48/81（59%）在 1 年随访时报告了症状，包括疲劳（38%）、注意力困难（25%）、健忘（25%）、睡眠障碍（22%）、肌痛（17%）、肢体无力（17%）、头痛（16%）、感觉障碍（16%）和嗅觉减退（15%）。神经系统检查显示 81 例患者中有 52 例（64%）存在异常，且无随时间改善（3 个月时为 61%，p=0.230），包括客观嗅觉减退（Sniffin' Sticks 测试<13；51%）。认知缺陷在 18%的患者中明显，而在感染后 1 年，分别有 6%、29%和 10%的患者出现抑郁、焦虑和创伤后应激障碍的迹象。这些精神和认知障碍在 3 个月的随访后并未改善（均 p>0.05）。
结论
我们的数据表明，相当数量的患者仍患有神经系统后遗症，包括神经精神症状，这表明需要对这些患者进行跨学科管理。
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